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Dr Basu, Experienced Specialist

Category: Medical

Satisfied Customers: 29245

Experience: MD

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I had my gallbladder removed 3 weeks ago (weighed 1.15kg and

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I had my gallbladder removed 3 weeks ago (weighed 1.15kg and no stones, sludge and sand only per surgeon and pathology report). Am not diabetic however, due to my sympoms (tired, sweaty and increased heart rate after light energy expenditure) and lab glucose of 196, my doctor has requested fasting fingersticks daily until my next visit. I am female, 50 years old, currently on Mimvey, Losartin 25mg day, Adderall 30mg twice per day and Allergra D as needed. It was determined that I needed IV fluids (2liters) and IV Magnesium (4grams) due to lab work 1 week ago.(.BUN 24, CREATININE 1.7, Mgnesium 1.7 ). After the IV fluids and magnesium, the symptoms above have pretty much resolved. The fasting fingersticks for 1 week have been between 101 and 108. My question... Are fasting fingersticks, in the ranges given, a reaon for concern?

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

Mysticdoc :

Hi there,

I am Mysticdoc, experienced Internal Medicine Specialist.

I am here to help you with your concerns.

Mysticdoc :

Magnesium deficiency and dehydration can explain your symptoms.

Mysticdoc :

You can continue with magnesium supplementatino at 400 mg daily to avoid any future deficiencies.

Mysticdoc :

Your current fasting blood sugar is not that concerning.

Mysticdoc :

Since these levels are above 100, you are considered prediabetic.

Mysticdoc :

A hemoglobin A1c level also should be checked by blodo test which provides average blood sugar level over prior 3 month period.

Mysticdoc :

You do not need any medication for blood sugar currently.

Mysticdoc :

However, you should watch your diet carefully.

Customer: The Onglyza, it did not seem to affect my fasting fingersticks. However, is it too early to make that determination? Should it take a few weeks to "kick in" or is it a medication that would start to working on day 1?

Mysticdoc :

onglyza can take 2 weeks

Mysticdoc :

It acts gradually.

Mysticdoc :

But, still it is likely working already since your fingerstick values are good.

Customer: But they were not very different before starting Onglyza.

Mysticdoc :

what were the numbers before onglyza?

Customer: 101-105

Customer: 102 - 108 after

Mysticdoc :

Ok --then you need to wait at least 2 weeks to see any difference.

Mysticdoc :

The goal is to keep blood sugar below 100.

Mysticdoc :

The dosage can be increased if needed after 2 weeks.

Customer: Should I be concerned about it gong too low if the fastings are now normal?

Mysticdoc :

No --the sugar will not go too low.

Mysticdoc :

Current numbers are also ok.

Mysticdoc :

Onglyza does not cause hypoglycemia usually.

Customer: I'm sorry, forgive me but, I don't understand. Onglyza is a "sugar pill". My numbers are okay. How can it not go too low yet, bring it lower if it's too high?

Mysticdoc :

Let me first explain how onglyza works.

Mysticdoc :

Onglyza prevents the destruction of incretin hormone in your intestine.

Mysticdoc :

Incretin is responsible through various mechanisms to prevent sugar production by the liver.

Mysticdoc :

So, it will maintain the normal blood sugar level throughout the day.

Mysticdoc :

but, this also prevents from spiking of the blood sugar level in the blood.

Mysticdoc :

So, at around 100 level, you will not see much difference.

Mysticdoc :

However, if your blood sugar is running for example above 140 before medication, then the level will be dropping around 100.

Mysticdoc :

So, in other words, onglyza is preventing your blood sugar to spike up currently.

Mysticdoc :

But, the sugar lvel will not drop lower usually with normal diet.

Mysticdoc :

Does i make sense?

Customer: Ahh, okay, I see. Onglyza does not work in the same way that other medications such as Metformin, insulin, etc. work?

Mysticdoc :

correct

Mysticdoc :

the mechanism of action is different.

Customer: The other medications will lower sugar period. Onglyza works as a "blocking agent" ( for lack of bette analogy) so that my body can self regulate?

Mysticdoc :

correct

Mysticdoc :

metformin also does the same action but works differently.

Mysticdoc :

insulin, and other meds like glipizide work differently.

Customer: Okay, thank you. I've seen people in the am when their sugar had fallen too low. That's vey scary! I was concerned about having a similar experience. She gave me Onglyza because I have only one functional kidney. Of course, we did not want to adversely affect my kidney function.

Mysticdoc :

Onglyza will not affect the kidney and your blood sugar will not drop due to the above reason.

Mysticdoc :

So you are safe.

Customer: Since I've never had any problem with my sugar, can surgery play a part in this sudden concern?

Mysticdoc :

yes it can --surgery related stress can cause spike in blood sugar.

Mysticdoc :

That is why a hemoglobin A1c level should be checked which measures the blood sugar average over 3 month period.

Customer: I have for many years checked my sugars occasionally because my mother was diabetic.

Mysticdoc :

ok

Mysticdoc :

Also your medications addrall and allegra D can increase the blood sugar level.

Customer: I believe my A1C the day before surgery was around 7. I was also running 103.4 temps and in a great deal if pain. And as said before my gallbladder was 1.15kg.

Mysticdoc :

ok

Mysticdoc :

that does suggest diabetes.

Mysticdoc :

But this is a mild disease now.

Mysticdoc :

And you should see improvement with onglyza.

Mysticdoc :

And since the gallbladder is out, your sugar should improve.

Customer: Am I thinking correctly in that due to the size of my gallbladder, it probably took awhile for it to make me accutely ill. Thus, that A1C level may have been elevated due to my gallbladder not functioning properly?

Mysticdoc :

No--it is the inflammation related to the gallbladder that can cause elevated blood sugar.

Mysticdoc :

Any inflammation in the body can increase the stress hormone levels which cause high blood sugar.

Customer: Thus, in a couple months that should also improve IF I am not truly diabetic?

Mysticdoc :

Gallbladder itself has no role with blood sugar level.

Mysticdoc :

correct in about 3 months.

Customer: Oh, okay. The acute illness and surgery would affect it though. Correct?

Customer: The fasting...not the A1C?

Mysticdoc :

yes correct -- A1c will not be affected significantly.

It was my pleasure to help you today.

Best wishes,

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